| NPI | 1871565325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SD 1421) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD 1421) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-10-10 |